HomeMy WebLinkAboutPermit Septic Tank 2001-02-20EI
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DETAILSYSTEM PLOTPLAN
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COMPLETION When signed by the County Sanitarian. This certificate is
at lhe above location.
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FOR SANITARIAN'S USE ONLY:
COMMENTS:
System Capacity
INSTALLATION RECORD & CERTIFICATE OF SATIS
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* ATTACH MATERIALS LIST
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m Corrected Dategal./day Signature
VICINITY MAP
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evidence as per ORS 454.665 of satrsfactory complelion of a subsurlace sewage d isposal system
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To requesl inspection, return all three (3) copies of this torm lo: LaneService Buitding, 125 E. Bth Avenue, eugenb, On giabf
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county Land Management Division, rocared in rhe basement of the pubric
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MATERIALS LIST
(Required) oAR 340-7 l- I 70(3Xb)
LANE COUNTY ON-SITE SEWAGE DISPOSAL PROGRAM
Office: (541) 682-3754 Fax: (541) 682-3947
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SEPTIC TAIYK
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6*ur", tightness tested after placement. Results within allowed limits. (Required)
E Riser (water tight).inches to ground surface. (Required)
E Effluent filter.
Anti-buoyancy provided as per mfg. specs.Arh
DISPoSALSYSTEM{trStd./SaprotiteoCap-fill*t]PressurizedDist.*DSandnilter+/.oth"@
*Alternative systems require additional
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i n formati or/i n specqi on s.
graveumedia fJlnD Curtain Drain: Depth of fench
D Effluent sewer pipe: Length
E Distribution material: Perforated pipe Oia. 4\i;"*
Outlet location V 14I
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D Drop / Distribution box installed. Mfg.\)Material
E Disposat Trench Total Length <3'Ir
D Orain media: Total depth 2J.{ tl
Depth below pipe lk I'Supplier U,gcr,q
ALLATION
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Pump Installer _
D Pump and float switches installed. Gallons / dose
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O Audible-visual alarm installed & tested. l,ocation
D Pressure pipe. Dia. ASTM PSI
0 Hydrosplitter Mfg./ Supplier
I undcrstand that I am rcsponsiblc for thc satisfactory complction ofall rcquircd tcsting corrcctions and final covcr ofthc systcm within 30
days of mmpletion. I ccrti$ that construction describcd abovc complies with the requircmcnts of Orcgon Administrative Rulcs Chaptcr 340
and thc pcrmit issucd by thc LANE COTNTY ON-SITE SEWAGE DISPOSAL PROGRAM.
INSTALLER SIGNATURE:
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ATTACH TO AS.BTIILT
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DATE:
A PRE.COVER INSPECTION WILI.NOT BE SCHEDULED I.JNTIL THIS MATERTALS LIST & AS-BUILT
DRAWINGARE SUBMITTED TO THE LANE COUNTY ON-SITE SEWAGE DISPOSAL PROGRAM.
Comments:
APPLICAhIT'S COPY
SEPTIC INSTALLATION PBRMIT
sP007444
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Parcels : 17 -03 -3 4-43 -06200
FRANKLIN BLVD TO CONCORD SOUTH TO E. 167
Applicant: RICHEY RON
PO BOX 7s15
EUGENE OR
9740t
Site
4029 E 16TH AVE EUG
Owner: SMITH ROBERT W
633 STAR TOUCH
EUGENE OR 97401
Site Inspection Number:
Work Description: REPAIR EXISTING SEPTIC SYSTEM
System Type: REPRMJR, STD2
Applied Date: 11127 12000
Approved Date: 12107 12000
Issued Date: 12107 12000
Expiration Date: 12107 12001
INSTALLATION REOUIREMENTS :
Projected Daily Flow: 450 gallons Septic Tank Size: 1000 gallons
Drainfield Size: 83 feet Maximum Depth of Drainfield: 30 in.
Special Conditions: INSTALL SEEPAGE TRENCHES ON
LEVEL IN AREA AS SHOWN ON
APPROVED PLOT PLAN
INSTALL 24" OF DRAIN ROCK WITH
6'' OF SOIL COVER
SANITATION SETBACK REOUIREMENTS:
From drainfield to property lines and structures: 10 feet
From drainfield to well: 100 feet
From septic tank to property lines and structures: 5 feet/:From septic tank to well: 5
Agent
1210712000
Date
To obtain an inspection, make a
drawing of the system as installed on the form provided. Submit the complete form to this oflice and the
inspection will be scheduled. Final inspection for sewage systems cannot be re+uested by telephone.
LANE CO{-]NTY ON-SITE-SEWAGE OFFICE
125 E 8TH Avenue, Eugene OR 97401. PH: (541) 682-3754. Fax: (541) 682-3947
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* ATTACH MATERIALS LIST
FOR SANTTABTAN'S USE ONLY: O System Approved 0 System Disapproved E Needs Correction
System CapacitY gal./day Signature
E System Corrected Date
Date
INSTALLATTON RECORD & CERTTFICATE OF SATISFACTORY COMPLETION When signed by the county sanitarian. ThiS certilicate is
evidence as per ORS 454.665 of satisfactory complelion ol a subsurface sewage disposal system at lhe above location.
To request inspection, return all three (3) copies of this torm to:Lane County Land Management Division, located in the basement of the Public
Service Building, 125 E. Bth Avenue, Eugene, OR 97401.
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